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   2015| January-March  | Volume 31 | Issue 1  
    Online since February 3, 2015

 
 
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ORIGINAL ARTICLES
Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: A prospective study
Osama A Shoair, Mario P Grasso II, Laura A Lahaye, Ronsard Daniel, Chuck J Biddle, Patricia W Slattum
January-March 2015, 31(1):30-36
DOI:10.4103/0970-9185.150530  PMID:25788770
Background & Aims: Postoperative cognitive dysfunction (POCD) is a decline in cognitive function that occurs after surgery. The purpose of this study was to estimate the incidence and identify potential risk factors of POCD in older adults undergoing major noncardiac surgery. Materials and Methods: A total of 69 patients aged 65 years or older undergoing major noncardiac surgery were enrolled. Patients' cognitive function was assessed before and 3 months after surgery using a computerized neurocognitive battery. A nonsurgical control group of 54 older adults was recruited to adjust for learning effects from repeated administration of neurocognitive tests. Data about potential risk factors for POCD were collected before, during, and after surgery, including patient, medication, and surgery factors. The incidence of POCD was calculated using the Z-score method. A multivariable logistic regression model was used to identify risk factors for POCD. Results: POCD was present in eleven patients (15.9%, 95% confidence interval [CI] = 7.3-24.6) 3 months after major noncardiac surgery. Carrying the apolipoprotein E4 (APOE4) genotype (odds ratio [OR] = 4.74, 95% CI = 1.09-22.19), using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery (OR = 5.64, 95% CI = 1.35-30.22), and receiving sevoflurane for anesthesia (OR = 6.43, 95% CI = 1.49-34.66) were associated with the development of POCD. Conclusions: POCD was observed in 15.9% of older adults after major noncardiac surgery. Risk factors for POCD in these patients were carrying the APOE4 genotype, using one or more highly anticholinergic or sedative-hypnotic drugs prior to surgery, and receiving sevoflurane for anesthesia.
  40 4,203 1,094
A comparative study between oral melatonin and oral midazolam on preoperative anxiety, cognitive, and psychomotor functions
Tushar Patel, Madhuri S Kurdi
January-March 2015, 31(1):37-43
DOI:10.4103/0970-9185.150534  PMID:25788771
Background & Aims: Melatonin, a naturally occurring hormone in the human body, has been reported to cause preoperative anxiolysis and sedation without impairing orientation. The aim of the following study was to evaluate and to compare the effects of oral melatonin and oral midazolam on preoperative anxiety, sedation, psychomotor, and cognitive function. Materials and Methods: A study conducted on 120 patients aged 16-55 years, of American Society of Anesthesiologists Grade 1 and 2 posted for elective surgery, with each group of melatonin, midazolam, and placebo comprising 40 patients. Patients were given either 0.4 mg/kg oral melatonin or 0.2 mg/kg oral midazolam or a placebo 60-90 min before induction. Preoperative anxiety was studied before and 60-90 min after giving medications using visual analog scale (VAS) anxiety score, orientation score, and sedation score. Psychomotor and cognitive functions were studied using the digit symbol substitution test (DSST) and trail making test (TMT) tests. Data were analyzed using Chi-square test or Kruskal-Wallis analysis of variance and the value of P < 0.05 was considered as statistically significant. Results: Changes in VAS anxiety scores were significant when melatonin was compared with placebo (P = 0.0124) and when midazolam was compared with placebo (P = 0.0003). When melatonin was compared with midazolam, no significant difference (P = 0.49) in VAS anxiety scores was observed. Intergroup comparison of sedation scores showed melatonin (P = 0.0258) and midazolam (P = 0.0000) to be statistically significant when compared with placebo. No changes in orientation scores occurred in melatonin and placebo group. Change in DSST scores and TMT scores were seen to be significant only in midazolam group. Conclusion: Oral melatonin 0.4 mg/kg provides adequate anxiolysis comparable to that of oral midazolam. Unlike midazolam, oral melatonin 0.4 mg/kg does not impair the general cognitive and psychomotor function especially cognitive aspects such as working memory, memory retrieval, sustained attention, and flexibility of thinking.
  12 4,714 845
LETTERS TO EDITOR
Ultrasound guided quadratus lumborum block or posterior transversus abdominis plane block catheter infusion as a postoperative analgesic technique for abdominal surgery
Vasanth Rao Kadam
January-March 2015, 31(1):130-131
DOI:10.4103/0970-9185.150575  PMID:25788791
  11 3,796 1,062
COMMENTARY
Monitored anesthesia care: An overview
S Das, S Ghosh
January-March 2015, 31(1):27-29
DOI:10.4103/0970-9185.150525  PMID:25788769
  10 2,780 1,473
ORIGINAL ARTICLES
Role of dexmedetomidine in early extubation of the intensive care unit patients
Shikha Gupta, Dupinder Singh, Dinesh Sood, Suneet Kathuria
January-March 2015, 31(1):92-98
DOI:10.4103/0970-9185.150554  PMID:25788780
Background and Aims: Patients on ventilatory support in intensive care unit (ICU) require sedation and analgesia to facilitate mechanical ventilation and endotracheal tube tolerance. The selection of the agent should be such that it does not interfere with the early extubation of the patients. We compared the efficacy of dexmedetomidine with midazolam to facilitate extubation of patients from mechanical ventilation in terms of the sedative properties, cardiovascular responses, ventilation, and extubation characteristics and safety profile. Materials and Methods: A total of 40 adult, mechanically ventilated patients of either sex, aged 18-60 years, meeting the standard criteria for weaning, randomized into 2 groups of 20 patients each, received intravenous infusion of dexmedetomidine (0.2-0.7 mcg/kg/h) or midazolam (0.04-0.2 mg/kg/h) as needed for Ramsay sedation scale 2-4. Extubation following standard extubation protocol was done. Time for extubation and vital parameters were regularly recorded. Results: The time to extubation in the dexmedetomidine group was significantly lower than in the midazolam group. Heart rate and blood pressure was significantly lower in dexmedetomidine group than the midazolam group at most of the times. Conclusions: Dexmedetomidine has clinically relevant benefits compared with midazolam in facilitating extubation due to its shorter time to extubation, more hemodynamic stability, easy arousability, and lack of respiratory depression.
  10 3,062 872
The analgesic efficacy of ultrasound-guided transversus abdominis plane block with mid-axillary approach after gynecologic laparoscopic surgery: A randomized controlled trial
Ryoko Kawahara, Yutaka Tamai, Kyoko Yamasaki, Satoko Okuno, Rumi Hanada, Takao Funato
January-March 2015, 31(1):67-71
DOI:10.4103/0970-9185.150547  PMID:25788776
Background and Aims: The transversus abdominis plane (TAP) block is widely used in clinical practice as a part of the multimodal analgesic regimen after abdominal surgery. The analgesic efficacy of ultrasound (US)-guided TAP block with the mid-axillary approach was investigated in patients undergoing laparoscopic gynecologic surgery in a randomized controlled clinical trial. Materials and Methods: Adult patients (n = 119) undergoing laparoscopic gynecologic surgery were randomized to undergo either TAP block with ropivacaine (Group A, n = 60) or that with saline (Group B, n = 59), in a blinded manner. Following general anesthesia, TAP block was performed bilaterally by infusion of either 20-mL 0.375% ropivacaine/one side in Group A or 20-mL saline/one side in Group B, under US guidance with a mid-axillary approach. Patient-controlled analgesia (PCA) was performed postoperatively with tramadol. The analgesic effect was postoperatively evaluated using a four-grade pain score and the prince Henry pain scale (PHS) at 0, 6, 12, and 24 h. Postoperative tramadol PCA consumption and vomiting/nausea were recorded. Statistical analyses were performed using the Mann-Whitney U-test or Fisher's exact probability test. A P < 0.05 was considered significant. Results: There was no statistically significant difference in background characteristics. The dose of remifentanil was significantly higher in Group B (P = 0.01). The pain score (P = 0.02) and PHS (P = 0.01) were significantly lower in Group A at 0 h. Tramadol PCA consumption in the period of 0-6 h (P = 0.01) and postoperative nausea (P = 0.04) were significantly less in Group A. Conclusion: Postoperative pain/nausea and PCA consumption were significantly lower in patients with TAP block in the early postoperative stage. TAP block with a mid-axillary approach holds considerable promise as a part of a balanced postoperative analgesic regimen following laparoscopic gynecologic surgery.
  9 2,413 484
REVIEW ARTICLES
Postoperative pain management in patients with chronic kidney disease
Qutaiba A Tawfic, Geoff Bellingham
January-March 2015, 31(1):6-13
DOI:10.4103/0970-9185.150518  PMID:25788766
Chronic kidney disease (CKD) is a health care problem with increasing prevalence worldwide. Pain management represents one of the challenges in providing perioperative care for this group of patients. Physicians from different specialties may be involved in pain management of CKD patients, especially in advanced stages. It is important to understand the clinical staging of kidney function in CKD patients as the pharmacotherapeutic pain management strategies change as kidney function becomes progressively impaired. Special emphasis should be placed on dose adjustment of certain analgesics as well as prevention of further deterioration of renal function that could be induced by certain classes of analgesics. Chronic pain is a common finding in CKD patients which may be caused by the primary disease that led to kidney damage or can be a direct result of CKD and hemodialysis. The presence of chronic pain in some of the CKD patients makes postoperative pain management in these patients more challenging. This review focuses on the plans and challenges of postoperative pain management for patient at different stages of CKD undergoing surgical intervention to provide optimum pain control for this patient population. Further clinical studies are required to address the optimal medication regimen for postoperative pain management in the different stages of CKD.
  9 6,507 1,809
ORIGINAL ARTICLES
Incidence and risk factors for oxygen desaturation during recovery from modified electroconvulsive therapy: A prospective observational study
Rohini Surve, Sonia Bansal, Kamath Sriganesh, Doddaballapur Kumaraswamy Subbakrishna, Jagadisha Thirthalli, Ganne Sesha Umamaheswara Rao
January-March 2015, 31(1):99-103
DOI:10.4103/0970-9185.150555  PMID:25788781
Background and Aims: Electroconvulsive therapy (ECT) is an established modality of treatment for severe psychiatric illnesses. Among the various complications associated with ECT, oxygen desaturation is often under reported. None of the previous studies has evaluated the predictive factors for oxygen desaturation during ECT. The objective of this study was to evaluate the incidence of oxygen desaturation during recovery from anesthesia for modified ECT and evaluate its risk factors in a large sample. Materials and Methods: All patients aged above 15 years who were prescribed a modified ECT for their psychiatric illness over 1 year were prospectively included in this observational study. The association between age, body mass index (BMI), doses of thiopentone and suxamethonium, stimulus current, ECT session number, pre- and post-ECT heart rate and mean arterial pressure, seizure duration, and pre- and post ECT oxygen saturation, was systematically studied. Results: The incidence of oxygen desaturation was 29% (93/316 patients). Seizure duration and BMI were found to be significantly correlated with post ECT desaturation. Conclusion: In this prospective observational study, the incidence of oxygen desaturation during recovery from anesthesia for ECT was high. The study identified obesity and duration of seizure as the independent predictors of this complication. This knowledge is likely to help in identifying and optimizing such patients before subsequent ECT sessions.
  8 1,780 327
REVIEW ARTICLES
Technological advances in perioperative monitoring: Current concepts and clinical perspectives
Geetanjali Chilkoti, Rachna Wadhwa, Ashok Kumar Saxena
January-March 2015, 31(1):14-24
DOI:10.4103/0970-9185.150521  PMID:25788767
Minimal mandatory monitoring in the perioperative period recommended by Association of Anesthetists of Great Britain and Ireland and American Society of Anesthesiologists are universally acknowledged and has become an integral part of the anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, transesophageal echocardiography, advanced neurological monitoring, improved alarm system and technological advancement in objective pain assessment. Various factors that need to be considered with the use of improved monitoring techniques are their validation data, patient outcome, safety profile, cost-effectiveness, awareness of the possible adverse events, knowledge of technical principle and ability of the convenient routine handling. In this review, we will discuss the new monitoring techniques in anesthesia, their advantages, deficiencies, limitations, their comparison to the conventional methods and their effect on patient outcome, if any.
  6 4,038 1,007
ORIGINAL ARTICLES
Do they hear what we speak? Assessing the effectiveness of communication to families of critically ill neurosurgical patients
Jacob Eapen Mathew, Jayraj Azariah, Smitha Elizabeth George, Sarvpreet Singh Grewal
January-March 2015, 31(1):49-53
DOI:10.4103/0970-9185.150540  PMID:25788773
Background and Aims: Clinician-family communication must be effective for medical decision making in any Intensive Care Unit (ICU) setting. We performed a prospective study to assess the effectiveness of communication to families of critically ill neurosurgical patients based on the two criteria of comprehension and satisfaction. Materials and Methods: The study was conducted on 75 patients in a 15 bedded neurosurgical ICU. An independent investigator assessed the comprehension and satisfaction of families between the 3 rd and the 5 th day of admission in ICU. Comprehension was tested using three components, that is, comprehension of diagnosis, prognosis and treatment. The satisfaction was measured using a modified version of the Critical Care Family Needs Inventory (CCFNI) (score of 56-extreme dissatisfaction and 14-extreme satisfaction). Results: Poor comprehension was noted in 52 representatives (71.2%). The mean satisfaction score as measured by the CCFNI score was 28. Factors associated with poor comprehension included increasing age of patient representative (P = 0.024), higher simplified acute physiology score (P = 0.26), nonoperated patients (P = 0.0087) and clinician estimation of poor prognosis (P = 0.01). Operated patients had significantly better satisfaction score (P = 0.04). Conclusion: Families of patients were reasonably satisfied, but had poor comprehension levels of the patient's illness. The severity of the patient's illness, poor prognosis as estimated by the physician and nonoperated patients were independent predictors of poor comprehension. Extra effort to communicate with patient representatives at risk of poor comprehension and provision of a family information leaflet could possibly remedy this situation.
  5 1,839 335
LETTERS TO EDITOR
In-plane interscalene block: A word of caution
Herman Sehmbi, Ushma J Shah
January-March 2015, 31(1):129-130
DOI:10.4103/0970-9185.150574  PMID:25788790
  4 3,329 386
ORIGINAL ARTICLES
Attenuation of hemodynamic response to laryngoscopy and orotracheal intubation using intravenous clonidine
Sakshi Arora, Anita Kulkarni, Ajay Kumar Bhargava
January-March 2015, 31(1):110-114
DOI:10.4103/0970-9185.150559  PMID:25788783
Background and Aims: Alpha-2 agonists are being increasingly used as adjuncts in general anesthesia and the present study was carried out to study the effect of clonidine as an adjuvant to low dose fentanyl in attenuating the hemodynamic response to laryngoscopy and orotracheal intubation. Materials and Methods : Ninety female patients belonging to American Society of Anesthesiologists (ASA) physical status I, II, and III in age group 25-65 years, body mass index (BMI) 21-26 kg/m 2 , and diagnosed as carcinoma breast scheduled for breast surgery were included in this Prospective, randomized, placebo-controlled study. One-way analysis of variance (ANOVA), paired t-test, and chi-square test was applied where deemed appropriate. P-value at or below the level of 0.05 was considered as statistically significant. Results: Intravenous (IV) clonidine 1.0 mg kg -1 and clonidine 2.0 mg kg -1 significantly attenuated the hyperdynamic response to laryngoscopy and intubation. Clonidine 2.0 mg kg -1 was associated with adverse effects like hypotension at the time of induction and postoperative sedation which was not observed with clonidine 1.0 mg kg -1 . Conclusions: A single intravenous low dose clonidine (1.0 mg kg -1 ) when combined with low dose fentanyl (2 mg kg -1 ) is a practical, pharmacological and safe method with minimal side effects to attenuate the hyperdynamic response to laryngoscopy and intubation.
  4 5,421 861
Cons and pros of female anesthesiologists: Academic versus nonacademic
Tarek Shams, Ragaa El-Masry
January-March 2015, 31(1):86-91
DOI:10.4103/0970-9185.150552  PMID:25788779
Background and Aims: We hypothesized that "Feminization" of medicine has an impact on the choice of anesthesiology as a specialty. However anesthesiology is still not a more popular choice among women in medicine. We aimed to evaluate the implications of anesthesiology as a profession on personal and family life of women anesthesiologists; the differences between academic and nonacademic women anesthesiologists with respect to these effects and the effect of women anesthesiologists on the profession. Materials and Methods: This study surveyed a total of 46 woman anesthesiologists; both academic and nonacademic institutions in our country between January and May 2013. A convenient sampling method was used. A constructed self-reported questionnaire was developed to explore the 29 items of woman-anesthesiology-related implications (family, personal, and job), in the form of close-ended questions. Results: Negative implications of anesthesiology on personal and family life of woman were common. With the exception of financial limitation, academic group was significantly more affected. Increased surgeons conflict (98%), poor surgeon acceptance (87%), poor patient acceptance and recurrent change of work schedule (80% each) were the most common perceived negative impacts of women in the field of anesthesiology. Some positive implications were perceived as independent, positive social interaction, empowerment, soothing work environment, emotional reaction to patient complaint, and increased perfectionism (nearly 94%, 98%, 87%, 91%, 89%, and 76%, respectively). Conclusion: Serious implications exist for the personality and family life of women who chose anesthesiology as a specialty and career, and most of these implications were significantly more prevalent among women with an academic career. Furthermore, anesthesiology as a profession was significantly affected by women joining the department.
  4 1,555 379
Dose-dependent effect of intrathecal dexmedetomidine on isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy: Effect on block characteristics and hemodynamics
Udita Naithani, Mahendra Singh Meena, Sunanda Gupta, Khemraj Meena, Lalatendu Swain, DS Pradeep
January-March 2015, 31(1):72-79
DOI:10.4103/0970-9185.150549  PMID:25788777
Background and Aims: Effect of intrathecal dexmedetomidine as an adjuvant to isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy is not much investigated. The objective was to assess the dose dependent effect of dexmedetomidine (3 mcg vs 5 mcg) as an adjunct to isobaric ropivacaine in spinal anesthesia. Materials and Methods: Forty selected female patients were randomized to receive intrathecal 0.5% isobaric ropivacaine (15 mg) with dexmedetomidine 3 mcg (Group D3) or 5 mcg (Group D5) in spinal anesthesia for abdominal hysterectomy. Block characteristics, hemodynamic changes, postoperative analgesia, and adverse effects were compared. Results: Both groups were comparable regarding sensory-motor block characteristics and postoperative analgesia (P > 0.05). Four (10%) patients of Group D5 and 5 (12.5%) of Group D3 could not achieve desired T6 sensory level and Bromage score of 3(complete motor block) hence were converted to general anesthesia at the outset. Nine (22.5%) patients each in both groups required ketamine supplementation (0.5 mg/kg) for intraoperative pain at the time of uterine manipulation. Incidence of hypotension was comparable (55.56% in Group D5 and 37.14% in Group D3, P = 0.11), but this occurred significantly earlier in Group D5, P < 0.001. Sedation was also significantly more in Group D5 as compared with Group D3, P < 0.01. Conclusion: We conclude that spinal anesthesia with isobaric ropivacaine (15 mg) with dexmedetomidine (3 mcg or 5 mcg) did not show much promise for abdominal hysterectomy as one third cases required analgesic supplementation. Both doses of dexmedetomidine produced a similar effect on block characteristic and postoperative analgesia; however, a dose of 5 mcg dose was associated with more hypotension and sedation.
  3 3,170 655
CASE REPORTS
Cesarean section under epidural anesthesia in a documented case of ruptured aneurysm of the sinus of valsalva
SR Divakar, Chandrashekhar Singh, Chandra Mohan Verma, Chaitanya D Kulkarni
January-March 2015, 31(1):119-122
DOI:10.4103/0970-9185.150565  PMID:25788785
Ruptured aneurysm of sinus of Valsalva (RSOV) occurring in pregnancy is a rare cardiac anomaly and it may be either congenital or acquired. Congenital sinus of Valsalva aneurysms are commonly associated with other structural defects such as ventricular septal defect (50-55%), aortic regurgitation (AR) (25-35%), bicuspid aortic valve (10-15%) and Marfan's syndrome (10%). RSOV in pregnancy accentuates the hemodynamic stress on maternal cardiovascular system and pose a significant challenge from obstetric anesthesia point of view. We report a case of 35-year-old documented patient of RSOV with mild AR presenting completely asymptomatic at 37 weeks 4 days of gestation. A successful elective lower segment cesarean section was conducted under epidural anesthesia.
  2 2,376 296
LETTERS TO EDITOR
Cutaneous fluid leakage after epidural catheter removal
Kajal S Dalal, Chellam Shrividya
January-March 2015, 31(1):133-134
DOI:10.4103/0970-9185.150581  PMID:25788793
  2 1,452 206
ORIGINAL ARTICLES
Regional anesthesia practice in Greece: A census report
Erifili Argyra, Eleni Moka, Chryssoula Staikou, Athina Vadalouca, Vassileios Raftopoulos, Evmorfia Stavropoulou, Zoi Gambopoulou, Ioanna Siafaka
January-March 2015, 31(1):59-66
DOI:10.4103/0970-9185.150545  PMID:25788775
Background and Aims: Regional anesthesia (RA) techniques (central neuraxial and peripheral nerve blocks [CNBs and PNBs]) are well-established anesthesia/analgesia modalities. However, information on their nationwide use is sparse. The aim of the survey was to assess the utility of RA techniques in Greece, during 2011. Materials and Methods: A nationwide, cross-sectional descriptive survey was conducted (March to June, 2012), using a structured questionnaire that was sent to 128 Greek Anesthesia Departments. Results: Sixty-six completed questionnaires (response rate 51.56%) were analyzed. The data corresponded to 187,703 operations and represented all hospital categories and geographical regions of Greece. On the whole, RA was used in 45.5% of performed surgical procedures (85,386/187,703). Spinal anesthesia was the technique of choice (51.9% of all RA techniques), mostly preferred in orthopedics (44.8%). Epidural anesthesia/analgesia (application rate of 23.2%), was mostly used in obstetrics and gynecology (50.4%). Combined spinal-epidural and PNBs were less commonly instituted (11.24% and 13.64% of all RA techniques, respectively). Most PNBs (78.5%) were performed with a neurostimulator, while elicitation of paresthesia was used in 16% of the cases. Conversely, ultrasound guidance was quite limited (5%). The vast majority of consultant anesthesologists (94.49%) were familiar with CNBs, whereas only 46.4% were familiar with PNBs. The main reported limitations to RA application were lack of equipment (58.23%) and inadequate education/training (49.29%). Conclusion: Regional modalities were routinely used by Greek anesthesiologists during 2011. Neuraxial blocks, especially spinal anesthesia, were preferred over PNBs. The underutilization of certain RA techniques was attributed to lack of equipment and inadequate training.
  2 1,831 265
Can cystatin C become an easy and reliable tool for anesthesiologists to calculate glomerular filtration rate?
Navpreet Kaur Aulakh, Ekta Bansal, Abhishek Bose, Gurmehar Singh Aulakh, Baldev Singh Aulakh, Mirley Rupinder Singh
January-March 2015, 31(1):44-48
DOI:10.4103/0970-9185.150538  PMID:25788772
Background and Aims: The aim was to evaluate the role of cystatin C as a noninvasive and easy marker of glomerular filtration rate (GFR) estimation in voluntary kidney donors. Materials and Methods: We retrospectively evaluated 40 voluntary kidney donors. They underwent complete biochemical and nuclear tests as a part of transplant workup. Serum cystatin C, serum creatinine, and Tc-99m diethylene-triamine-penta-acetic acid (DTPA) were used in our study. We calculated GFR using the chronic kidney disease epidemiology collaboration (CKD-EPI) formula based on creatinine only (GFR-CKD-EPI-creat), CKD-EPI formula using creatinine and cystatin C (GFR-CKD-EPI-cyst-creat), and modification of diet in renal disease (MDRD) and CKD-EPI cystatin C equation (2012) (GFR-cyst). Data was evaluated using the SPSS software (version 11.5). The correlation analysis and analysis of variance was used for statistical computation. Agreement was determined using analyze-it version 2.30 for MS-Excel 12+. Results: The mean age of the donors in our study was 49.83 ± 13.06. The mean cystatin C in females was 0.72 ± 0.12, the mean cystain C in males was 0.87 ± 0.23. On correlating GFR-cyst with GFR-DTPA the Pearson correlation coefficient (ρ) was found to be 0.388 this correlation was significant with P < 0.05. While comparing with DTPA the correlation coefficient of GFR-CKD-EPI-creat group was 0.587 which was significant with P < 0.01. The correlation coefficient of GFR-CKD-EPI-cyst-creat group compared with GFR-DTPA group was 0.543 which was also significant at P < 0.001. GFR-CKD-EPI-creat gave the highest correlation with DTPA in our study. The correlation coefficient of GFR-MDRD group with DTPA group was 0.576 this correlation was also significant with P < 0.01. The results obtained were further statistically analyzed by Bland-Altman analysis the percentage error for GFR-DTPA versus GFR-cyst-creat is 29.72%; for GFR-DTPA versus GFR-EPI-creat is 30.73%; or GFR-DTPA versus MDRD is 31.63% and for GFR-DTPA versus GFR-cyst is 34.37%. Conclusion: Cystatin C is a good endogenous marker for calculating GFR as it correlates very well with DTPA and CKD-EPI equation based GFR.
  2 1,775 283
CASE REPORTS
Unanticipated cannot intubate situation due to difficult mouth opening
Karunakara Rao Akasapu, Sridhar Wuduru, Narmada Padhy, Padmaja Durga
January-March 2015, 31(1):123-124
DOI:10.4103/0970-9185.150568  PMID:25788786
We report a case of unanticipated difficult endotracheal intubation secondary to an abrupt onset of difficulty in opening the mouth in an anesthetized adult. A female aged 76 years with American Society of Anesthetists risk Class IV E with an apparently normal preoperative temporomandibular joint was scheduled for emergency laparotomy. Following rapid sequence induction, and muscle relaxation with rocuronium, the anesthesiologist noticed lock-jaw when intubation was attempted. She was ventilated with nasopharyngeal airway, but was progressively desaturating. An emergency tracheostomy was performed. Unfortunately, she sustained cardiac arrest and could not be revived. The complication of the lock-jaw is a nightmare to airway management, especially in an unprepared situation.
  1 1,876 337
EDITORIALS
Responsibility and accountability
Rebecca Jacob
January-March 2015, 31(1):1-3
DOI:10.4103/0970-9185.150512  PMID:25788764
  1 1,842 353
ORIGINAL ARTICLES
Efficacy of caudal fentanyl and ketamine on post-operative pain and neuroendocrine stress response in children undergoing infraumbilical and perineal surgery: A pilot study
Sharmila Ahuja, Sangeeta Yadav, Nandita Joshi, Sujata Chaudhary, SV Madhu
January-March 2015, 31(1):104-109
DOI:10.4103/0970-9185.150558  PMID:25788782
Background and Aims: It is well-known that neuroendocrine stress response (NESR) occurs in children and it can be modified by caudal block. However, there is paucity of literature comparing caudal fentanyl and ketamine on NESR. The present study was aimed to compare the analgesic efficacy of these caudal adjuvants and their effect on (NESR) in children undergoing infraumbilical and perineal surgery. Materials and Methods: A total of 60 children undergoing infraumbilical surgery were included in this randomized, double-blind study. Three groups of 20 each were assigned to receive caudal block with bupivacaine 0.25% 1 ml/kg along with either 0.9% normal saline (Group I) 1 μg/kg fentanyl (Group II) or 0.5 mg/kg ketamine (Group III). Modified visual analogue scale (VAS) was used for assessment of post-operative pain, and stress response was assessed by blood glucose, serum cortisol and insulin levels at various time intervals Results: VAS scores were significantly lower in the ketamine group at all-time intervals upto 4 h (P < 0.05). Patients in ketamine group required rescue analgesia significantly later (8.23 h) when compared to fentanyl (5.95 h) and bupivacaine group (4.10 h). Caudal block led to significant decrease in cortisol and insulin levels within the groups however this significance was not achieved between groups. Conclusion: Caudal ketamine in a dose of 0.5 mg/kg provides prolonged analgesia when compared to fentanyl 1 μg/kg. Blunting of the NESR was observed in all the groups though the indicators of the response were lowest with ketamine.
  1 2,597 434
Comparison between intravenous paracetamol and fentanyl for intraoperative and postoperative pain relief in dilatation and evacuation: Prospective, randomized interventional trial
Muhammad Asghar Ali, Faisal Shamim, Shakaib Chughtai
January-March 2015, 31(1):54-58
DOI:10.4103/0970-9185.150542  PMID:25788774
Background and Aims: Dilatation and Evacuation procedure involves pain, for which pain control measures need to be undertaken. The purpose of this study was to compare paracetamol with fentanyl for pain relief in dilatation and curettage procedures. Materials and Methods: Sixty female patients were randomly included during the period from March 1, 2012 to February 28, 2013. All patients had received oral midazolam 7.5 mg as a premedication 30 min before procedure in the ward. Group P had received intravenous (IV) paracetamol 15 mg/kg in the waiting area of the operating room 15 min before starting the procedure. Group F had received IV fentanyl 2 ug/kg/min at induction of anesthesia. Pain scores on a numerical rating scale at 5, 15, and 30 min intervals after surgery were recorded. Results: Mild pain was commonly observed in both groups, an insignificant difference between groups. Conclusion: The study demonstrates the usefulness of IV paracetamol which may be as effective as fentanyl in dilation and curettage procedures.
  1 3,092 518
COMMENTARY
Retroperitoneal versus transperitoneal approach for nephrectomy in children: Anesthetic implications
Neerja Bhardwaj
January-March 2015, 31(1):25-26
DOI:10.4103/0970-9185.150523  PMID:25788768
  - 1,462 258
EDITORIALS
Vistas for the future
Anju Grewal
January-March 2015, 31(1):4-5
DOI:10.4103/0970-9185.150514  PMID:25788765
  - 1,230 230
FORUM
Pediatric retroperitoneoscopic nephrectomy: An initial experience of 15 cases
Souvik Maitra, Puneet Khanna, Dalim Kumar Baidya, Dilip Kumar Pawar, Minu Baipai, Shasanka Shekhar Panda
January-March 2015, 31(1):115-118
DOI:10.4103/0970-9185.150560  PMID:25788784
Retroperitoneoscopic approach of nephrectomy in pediatric patients is a debatable issue from surgical point of view. Experience of anesthetic management of 15 such patients from a tertiary care teaching hospital has been described here. We found that capno-retroperitoneum increases end-tidal carbon-di-oxide, but normocapnea was achieved in the most of the patients. No significant hemodynamic changes were noted in any patients. However, subcutaneous emphysema was common, but self-limiting without any serious consequence. Postoperative pain after this procedure is usually manageable by nonopioid analgesics.
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LETTERS TO EDITOR
Common gas outlet error leading to severe hypoxia and general anesthesia during cesarean section under spinal anesthesia
PL Narendra, KN Gurudatta, Brian Jenkins
January-March 2015, 31(1):125-126
DOI:10.4103/0970-9185.150571  PMID:25788787
  - 1,256 226
Neuro-anesthesia handover checklist
Faraz Shafiq, Muhammad Irfan Ul Haq
January-March 2015, 31(1):126-127
DOI:10.4103/0970-9185.150572  PMID:25788788
  - 1,586 276
The wonderful world of medical apps
Herman Sehmbi
January-March 2015, 31(1):127-128
DOI:10.4103/0970-9185.150573  PMID:25788789
  - 1,189 258
The A.P. Advance video laryngoscope as a rescue airway device in an unpredicted difficult airway
Salvatore Zampone, Ruggero Massimo Corso, Laura Parrinello, Giorgio Gambale, Massimiliano Sorbello
January-March 2015, 31(1):134-136
DOI:10.4103/0970-9185.150589  PMID:25788794
  - 1,163 199
An unusual cause of electrocardiogram interference in the operation theater
Ankur Sharma, Renu Sinha
January-March 2015, 31(1):131-132
DOI:10.4103/0970-9185.150576  PMID:25788792
  - 1,099 181
ORIGINAL ARTICLES
Development and implementation of a dedicated postoperative evaluation service to improve compliance of postoperative visits
Joshua Charles Vacanti, Richard Dennis Urman, Pankaj Sarin, Xiaoxia Liu, Bhavani Shankar Kodali
January-March 2015, 31(1):80-85
DOI:10.4103/0970-9185.150550  PMID:25788778
Background and Aims: Postoperative patient evaluation is an integral component of perioperative care. An audit of our anesthesia department's records demonstrated a compliance rate of <50%. We postulated that the development of clinical anesthesia service dedicated to performing such evaluations would improve compliance significantly. Materials and Methods: This retrospective study examined postoperative follow-up completion rate at a large academic center. Data were collected from 58,000 anesthetics during three periods, between each of which an intervention was introduced. The first period examined completion rate when postoperative evaluations were left to the team performing the anesthetic. During the second period, this task was delegated to groups of anesthesiologists based on surgical subspecialty; these smaller groups utilized rotating residents. The third period examined completion rate after implementation of a postoperative evaluation service. All periods utilized the department's electronics database to identify operative patients. The number of adverse anesthesia events reported was also recorded. Results: A significant difference in the proportions of compliance with postoperative evaluations among all three periods was detected. Compliance was 47% during period one and improved to 66% during period two. During period three, which employed a postoperative evaluation service, compliance was 83%. The number of adverse events reported per month increased significantly following the first study period from 95 reported monthly events to 215 and 201 in the second and third periods, respectively. Conclusion: By creating a dedicated postoperative evaluation service using available technology, we improved postoperative evaluation completion rate from 47% to 83%, and demonstrated a significant increase in the number of adverse events reported. Based on this, we support the deployment of a dedicated service as a quality improvement initiative.
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RESEARCH SOCIETY OF ANAESTHESIOLOGY CLINICAL PHARMACOLOGY (RSACP): MINUTES OF GBM 2014
Research Society of Anaesthesiology Clinical Pharmacology (RSACP) Minutes of GBM held on 15 th November 2014, at Dehradun (Uttarakhand)
Naveen Malhotra
January-March 2015, 31(1):137-139
DOI:10.4103/0970-9185.150596  
  - 4,157 183
RSACP RESEARCH AWARDS
RSACP Research Awards
Naveen Malhotra
January-March 2015, 31(1):136-136
DOI:10.4103/0970-9185.150593  
  - 876 138
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